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As one of the dwindling number of people who still watches network television sitcoms, I continue to be fascinated by the willingness of the producers of these shows to explore issues that do not often appear in public policy debates.
An example is the CBS comedy Bob Hearts Abishola, which has a number of important messages for elected officials about health care, immigration, and aging. Unfortunately, what the show is telling us is contradictory to what our politicians think people want to hear about these issues.
The premise of this sitcom involves the owner of a sock manufacturing company (Bob) suffering a heart attack and falling in love with his cardiac nurse (Abishola), who happens to be an immigrant from Nigeria. The plot thickens when Bob’s mother suffers a stroke, and Abishola takes on a caregiving role in addition to her job at the local hospital.
If you get beyond the unlikely romance and the quirkiness of Bob’s dysfunctional siblings, the show reveals a situation encountered by countless families. An aging parent is suddenly incapacitated. The family decides to care for her at home. They quickly find themselves overwhelmed and are forced to find outside assistance in order to make their plan work.
In real life, of course, the eldest son hasn’t fallen in love with a nurse, so most families face a difficult search in a caregiving system that can be difficult to navigate. In many cases finding a caregiver in a crisis situation is extraordinarily difficult, and if a family does find someone, it may only be a temporary solution.
As our population grows older we will need more caregivers, but where will we find them? This U.S. Census Bureau Quarterly Workforce Indicators chart showing the makeup of the healthcare and social assistance workforce in the Pittsburgh Metropolitan area paints a grim picture (h/t to Joe Angelelli, gerontologist extraordinaire who continues to do important work on aging issues in Western Pennsylvania, for bringing this to my attention).
It shows the need for these workers has increased significantly over the past 25 years. But the workforce growth has been in workers aged 55 and older – and those workers are rapidly aging out of a profession that is incredibly demanding both physically and emotionally.
Meanwhile, younger people are not flocking to this career. And why should they? It is not an easy job and it takes a person with a strong commitment to helping others. But even for those with an inclination toward this type of work, the salary it pays makes it a questionable choice.
Many of those needing caregiving assistance are lower-income and qualify for Medicaid assistance. Elected officials, however, have refused to provide the necessary funding to allow Medicaid to pay adequate wages for direct care workers. In Pennsylvania, the General Assembly feels it is more important to maintain our regressive tax system than to adequately compensate caregivers in order to make the profession more competitive with other careers.
Which brings us back to Bob Hearts Abishola. It is no coincidence the subject of Bob’s affections is a nurse from another country. With the employment picture in the United States continuing to produce more job openings than people able to fill those positions, hospitals and other medical facilities are recruiting in other countries.
Skilled care nurses are in high demand and the hospital where Bob received his care undoubtably went to great lengths to bring Abishola to fill a needed position. And she was available to help provide caregiving to Bob’s mother.
But most home health care agencies do not have the resources to recruit for caregivers in other countries. And too many elected officials, who will not provide the funding to make caregiving an adequately paid profession for workers in the United States, work hard to discourage immigration and prejudice the United States population against immigrants.
The unfortunate fact, of course, is our history shows it takes little persuasion to turn many people in the U.S. against those from other countries.
At this time of demographic change, we simply cannot continue to refuse to acknowledge the true costs of providing care to our older population and at the same time disparage those from other countries who will come to the United States to fill the growing gaps in our workforce.
Network sitcoms such as Bob Hearts Abishola have a thoughtful, but happy, message to convey. But to truly reflect the reality of our caregiving and immigration situation, this show may need to morph into a tragedy if we continue down our current path.
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